PER JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER

          This appeal has been filed by the appellant against the order dated 6.1.2014 passed by the learned State Consumer Disputes Redressal Commission, Kolkata (in short, ‘the State Commission’) in Consumer Complaint No. 70/2013 – Sibaji Sen Vs. The Oriental Ins. Co. Ltd. & Ors. by which, application of OP No. 3 for deletion of his name was allowed.

2.      Brief facts of the case are that complainant/appellant obtained medi-claim insurance from OP No. 1/Respondent No. 1 for a sum of Rs.2,00,000/-.  On 10.3.2011, complainant became sick and was admitted in hospital of OP No. 3/Respondent No.3 and OP No. 3 / Respondent No. 3 applied on behalf of complainant to OP No. 2/Respondent No. 2 for obtaining cashless facility.  Complainant was discharged on 30.3.2011 and OP No. 3 raised bill for Rs.1,84,104/-, but OP No. 1 & 2 paid only Rs.88,240/- and refused to pay balance amount as not reasonable or customary. It was further alleged that if bills raised by OP No. 3 were not reasonable or customary, he has right to claim the amount from OP No. 3.  Alleging deficiency on the part of OPs filed complaint before State Commission for refund of aforesaid amount along with pre and post hospital expenses and for mental agony and harassment. OP No. 3 moved an application for deletion of his name and learned State Commission vide impugned order deleted his name from roll of complaint against which, this appeal has been filed.

3.      Heard appellant in person and Counsel for respondents finally at admission stage and perused record.

4.      Learned Counsel for the appellant who himself is an Advocate submitted that he has filed complaint alleging deficiency on the part of all the OPs including OP No. 3 on the ground that OP No. 3 raised bill arbitrarily in violation of terms & conditions of policy; even then, learned State Commission committed error in deleting his name; hence, appeal be allowed and impugned order be set aside.  On the other hand, learned Counsel for the Respondent No. 3 submitted that as there is no medical negligence on the part of OP No. 3, order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed.

5.      Perusal of complaint clearly reveals that complainant claimed reimbursement of expenses incurred in treatment in hospital of OP No. 3 from OP No. 1 & 2. OP No. 1 & 2 repudiated part of claim on the ground that as per policy T & C, under reasonable and customary expenses clause, turp is payable upto 80k hence no further authorisation is possible.  In such circumstances, complainant filed complaint against OP No. 1 & 2 including OP No 3 on the alternate ground that OP No. 3 has raised bill arbitrarily and in violation of terms and conditions of the policy.  As complainant has alleged deficiency on the part of all the OPs including OP No. 3, there was no occasion for the State Commission to delete name of the OP No. 3 at initial stage.  OP No. 3 is not only proper party, but also a necessary party as complainant is claiming compensation from OP No. 3 also.  Whether complainant would be able to prove his case against OP No. 3 or not, this is not to be seen at this stage of complaint.

6.      Learned Counsel for the respondent No. 3 submitted that no medical negligence has been imputed on the part of OP No. 3.  It is true that this complaint has not been filed on the basis of medical negligence on the part of OP No. 3, but has been filed on account of rejection of reimbursement of expenses as well on account of raising arbitrarily bill in violation of terms and conditions of policy by OP No. 3 and in such circumstances, OP No. 3 cannot be deleted from the array of parties.

7.      Consequently, appeal filed by the appellant is allowed and impugned order dated 6.1.2014 passed by learned State Commission in Consumer Complaint No. 70/2013 – Sibaji Sen Vs. The Oriental Ins. Co. Ltd. & Ors. is set aside with no order as to costs.